What are Learner and Instructor Preferences for Group Size and Composition for a Series of Synchronous Online Case Discussions for Upper Extremity Trauma Surgeons?

Figures & data

Table 1. Profiles of registered participants obtained from the pre-event standard questionnaire

Question	Response options	Responses (n = 89)
When did you graduate from medical school?	0–2 years ago	4%
	3–5 years ago	14%
	6–10 years ago	28%
	11–15 years ago	30%
	More than 15 years ago	24%
Country	Bahrain, Belarus (3), Belgium (2), Bulgaria, Croatia, Czech Republic (2), Egypt (8), Georgia, Germany (3), Greece (2), Hungary, Israel, Italy (3), Jordan (14), Kenya, Kuwait, Lebanon (3), Moldova (2), Nigeria (2), North Macedonia, Oman (5), Pakistan (4), Palestine, Poland, Portugal (2), Romania, Russia (3), Saudi Arabia (5), South Africa (3), Spain (2), Sweden, Switzerland, Turkey (2), Tunisia (4), Ukraine (5), United Arab Emirates, UK (6)
Type of practice I do mostly … (> 50% of time):	Orthopaedic trauma	64%
	General orthopaedics (joint replacement, etc.)	14%
	General trauma	8%
	Speciality orthopaedics (e.g. sports injuries, shoulder surgery)	7%
	Other	7%
My self-assessed expertise level is …	Orthopaedic trauma	Low 8%, Medium 57%, High 36%
	Shoulder and elbow surgery	Low 43%, Medium 49%, High 8%
	Hand and wrist surgery	Low 35%, Medium 47%, High 18%
How many cases do you treat on average per month on the topic(s) covered in this event?	1–5 cases	25%
	6–10 cases	36%
	11–15 cases	12%
	16–20 cases	17%
	More than 20	10%
What is your main practice location?	Level I trauma center (full range of specialists and equipment available 24 hours a day)	29%
	Level II trauma center (24-hour availability of all essential specialities, personnel, and equipment)	28%
	Local or community hospital (resources for emergency resuscitation, surgery, and intensive care of most trauma patients)	15%
	University hospital	25%
	Private practice	3%
What is your present and desired level of ability for the following competencies (C)?		Present level	Gap to desired level (motivation)
	C1: Perform an appropriate assessment of the patient with trauma to the shoulder, humeral shaft, elbow, forearm, wrist, and hand	3.56	1.24
	C2: Identify the minimal quality requirements for each assessment tool and the optimal way to gather the required information	3.31	1.40
	C3: Perform a thorough, stepwise analysis of the problem (what is the mechanical, biological, and soft tissue situation and problem)	3.29	1.44
	C4: Identify the advantages and disadvantages of the treatment options and decide with the patient which is best for their specific needs	3.42	1.39
	C5: Develop a comprehensive plan based on the needs of the patient, the injury, the patient factors, and the available surgical options	3.43	1.38
	C6: Complete the plan (perform operative procedures and nonoperative care)	3.33	1.46
	C7: Provide and communicate overall care, integrating the team, family, and supporting care system	3.36	1.35

Table 2. Comparison of post-course standard evaluation ratings (on a 1 to 5 Likert scale) of face-to-face upper extremity course in 2019 and online offerings in 2020 (in grey the 8 consecutive weeks course)

	Course	Impact	Met objectives	Content	Faculty	Recommend	Venue/location
Face-to-face	Upper Extremity n = 11	4.9	4.25	4.36	4.64	100%	4.27
	Upper Extremity n = 38	5	4.47	4.5	4.47	97%	3.5
	Upper Extremity n = 18	4.72	4.36	4	4	100%	2.89
	Upper Extremity n = 7	4.85	4.71	3.71	4	100%	3.43
	Upper Extremity n = 14	4.71	-	4.07	3.86	100%	3.64
Online	Upper Extremity 8 consecutive weeks n = 61	4.72	4.34	4.16	4.21	100%	3.49
	Infection 3 weeks, twice weekly n = 27	4.81	4.53	4.07	3.97	97%	3.5
	Soft tissue 4 weeks, twice weekly n = 40	4.43	4.08	3.69	3.79	92%	3.21
	Shoulder 3 consecutive half days n = 31	4.9	4.17	4.16	4.1	100%	3.39
	Elbow 3 consecutive half days n = 33	4.96	4.26	4.36	4.21	100%	3.39
	Shoulder 3 consecutive half days n = 21	4.76	4.2	4.05	4.24	93%	3.43

Figure 1. Pre- and post-course motivation to learn (difference between present and desired level of ability on a 1 to 5 Likert scale) per competency (C) and pre- and post-course knowledge test (multiple-choice questions MCQs)

Table 3. Content (cases) and online experience ratings on a 1 to 5 Likert scale for the 8 modules (by subgroup)

	Faculty	Participants in larger group with 2 faculty	Participants in smaller group with 1 faculty
Cases in small group discussions (average)
Module 1	3.96	3.91	4.22
Module 2	4.39	4.14	4.17
Module 3	3.43	4.29	4.40
Module 4	4.33	4.11	3.80
Module 5	3.67	4.00	3.80
Module 6	4.16	3.94	4.24
Module 7	3.88	4.22	4.07
Module 8	3.93	4.21	4.26
Online experience
Module 1	3.35	3.75	4.00
Module 2	3.00	3.72	3.35
Module 3	3.50	3.89	3.75
Module 4	3.58	3.79	3.83
Module 5	2.92	3.40	3.52
Module 6	3.20	3.52	3.76
Module 7	3.83	4.00	3.82
Module 8	3.42	3.91	4.13

Table 4. Combined results of the post-course questionnaire. N = 56 participants (62% completion rate) and n = 31 faculty (91% completion rate)

Statement or question	Responders	Disagree strongly		Disagree			Neutral		Agree		Agree strongly
When all the technical issues are addressed, online small group discussions can run just as well as in a face-to-face environment	Participants	0%		0%			15%		45%		31%
	Faculty	6%		32%			13%		39%		10%
8 weekly modules made the online course too long	Participants	9%		29%			16%		33%		13%
	Faculty	0%		19%			29%		35%		16%
90 minutes each module was adequate for discussing 3 cases	Participants	0%		7%			11%		58%		24%
	Faculty	0%		10%			13%		55%		23%
The pre-course questions and pre-recorded presentation enhanced the online discussions	Participants	0%		2%			16%		38%		44%
	Faculty	0%		3%			16%		55%		26%
Meeting and interacting with peers from other countries and regions is very valuable	Participants	0%		2%			4%		33%		62%
	Faculty	0%		0%			3%		32%		65%
Small group discussions online provide me with an opportunity that I could not access in any other way even in normal circumstances	Participants	0%		4%			16%		44%		36%
	Faculty	3%		10%			10%		48%		29%
Small group discussions online should stop once face-to-face education can resume	Participants	31%		38%			16%		7%		7%
	Faculty	16%		55%			16%		6%		6%
What is the best rotation plan for participants?		Stay in a fixed group for all 8 weeks			Stay in a fixed group for 4 weeks then switch for 4 more					Move to a new group every week
	Participants	18%			35%					47%
	Faculty	3%			52%					45%
What is the best rotation plan for faculty?	Participants	5%			27%					67%
	Faculty	3%			45%					52%
From your experiences up to now in the overall course, please rate each of the following ways to run online small groups?		1 faculty with 4 or 5 participants	1 faculty with 8 participants			2 faculty with 4 or 5 participants		2 faculty with 8 participants				Any size (if connections are good)
	Participants	Is best: 13% Works well: 48%	Is best: 4% Works well: 6%			Is best: 47% Works well: 33%		Is best: 20% Works well: 34%				Is best: 7% Works well: 14%
	Faculty	Is best: 24% Works well: 60%	Is best: 0% Works well: 8%			Is best: 23% Works well: 38%		Is best: 33% Works well: 50%				Is best: 4% Works well: 4%

Table 5. Subcategories of statements about what went well and about what we could do differently next time

What went well
Total comments	167
From participants	95	57%
From faculty	72	43%
IT Support and platform	15	9%
Organization and timing	21	13%
Cases and topics	55	33%
Group size and discussion	36	22%
Improvement throughout the courses	4	2%
What could be done differently next time
Total comments	128
From participants	68	53%
From faculty	60	47%
Technical issues	27	21%
Timing issues	34	27%
Contextual	33	26%
Pricing	7	5%
Group size	11	9%

Table

Recommendations for participants
Prepare yourself beforehand (introduction video, articles, surgical techniques)	Apply virtual meeting etiquette (minimise background noise, use a headset, adapt the lighting, mute/unmute)
Ensure high-speed internet connection	Participate actively
Connect on time and in a space where you have no distractions	Schedule all meetings in your own calendar
Get to know the virtual learning environment (hand raising icon, pointing arrow, chat function)	Do not hesitate to interact with faculty and participants (AO family concept)
Be open-minded	Share your own experiences
Be aware that nonverbal communication, such as facial expression, is less clear	Make sure to have a basic level of English
Connect via a computer rather than using a smartphone or tablet

Table

	Stay in a fixed group for all 8 weeks	Stay in a fixed group for 4 weeks then switch for 4 more	Move to a new group every week
Participants
Faculty

Table

	Not good	Works OK	Works well	Is the best
1 faculty with 4 or 5 participants
1 faculty with 8 participants
2 faculty with 4 or 5 participants
2 faculty with 8 participants
Any size (if connections are good)

Table

	Disagree strongly	Disagree	Neutral	Agree	Agree strongly
When all the technical issues are addressed, online small group discussions can run just as well as in a face-to-face environment
8 weekly modules made the online course too long
90 minutes each module were adequate for discussing 3 cases
The pre-course questions and pre-recorded presentation enhanced the online discussions
Meeting and interacting with peers from other countries and regions is very valuable
Small group discussions online provide me with an opportunity that I could not access in any other way even in normal circumstances
Small group discussions online should stop once face-to-face education can resume